|
TC 99M SULFUR COLLOIDPER DOS(T
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
340T0056
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.24
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
TCAT DLVR ENHNCD FIXJ DEV
|
Professional
|
Both
|
$1,540.00
|
|
|
Service Code
|
HCPCS 34712
|
| Hospital Charge Code |
76103025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$1,253.62 |
| Rate for Payer: Ambetter Exchange |
$612.53
|
| Rate for Payer: Anthem Medicaid |
$547.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$735.04
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: Cash Price |
$770.00
|
| Rate for Payer: Cigna Commercial |
$1,253.62
|
| Rate for Payer: Humana Medicaid |
$547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$912.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$558.92
|
| Rate for Payer: Molina Healthcare Passport |
$547.96
|
| Rate for Payer: Multiplan PHCS |
$924.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$796.29
|
| Rate for Payer: UHCCP Medicaid |
$539.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$553.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.53
|
|
|
TCAT INSJ/RPL PERM LDLS PM
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33274
|
| Hospital Charge Code |
76102882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.08 |
| Max. Negotiated Rate |
$24,669.92 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,621.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,669.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,788.85
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Humana Medicare Advantage |
$17,621.37
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,145.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
TCAT INSJ/RPL PERM LDLS PM
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33274
|
| Hospital Charge Code |
76102882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$893.36 |
| Rate for Payer: Ambetter Exchange |
$445.15
|
| Rate for Payer: Anthem Medicaid |
$395.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$445.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$445.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$534.18
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$893.36
|
| Rate for Payer: Humana Medicaid |
$395.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$445.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$403.42
|
| Rate for Payer: Molina Healthcare Passport |
$395.51
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$578.70
|
| Rate for Payer: UHCCP Medicaid |
$411.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$399.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$445.15
|
|
|
TCAT INSJ/RPL PERM LDLS PM
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 33274
|
| Hospital Charge Code |
76102882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
TCD VASACTIVITY STDY W/INJ
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,058.88 |
| Rate for Payer: Aetna Commercial |
$849.31
|
| Rate for Payer: Anthem Medicaid |
$379.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$860.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$551.50
|
| Rate for Payer: Cash Price |
$551.50
|
| Rate for Payer: Cigna Commercial |
$915.49
|
| Rate for Payer: First Health Commercial |
$1,047.85
|
| Rate for Payer: Humana Commercial |
$937.55
|
| Rate for Payer: Humana KY Medicaid |
$379.32
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$383.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$904.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$386.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$970.64
|
| Rate for Payer: Ohio Health Group HMO |
$827.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.07
|
| Rate for Payer: PHCS Commercial |
$1,058.88
|
| Rate for Payer: United Healthcare All Payer |
$970.64
|
|
|
TCD VASACTIVITY STDY W/INJ
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$661.80 |
| Rate for Payer: Aetna Commercial |
$239.03
|
| Rate for Payer: Ambetter Exchange |
$298.68
|
| Rate for Payer: Anthem Medicaid |
$174.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.42
|
| Rate for Payer: Cash Price |
$551.50
|
| Rate for Payer: Cash Price |
$551.50
|
| Rate for Payer: Cigna Commercial |
$331.11
|
| Rate for Payer: Healthspan PPO |
$255.34
|
| Rate for Payer: Humana Medicaid |
$174.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.60
|
| Rate for Payer: Molina Healthcare Passport |
$174.12
|
| Rate for Payer: Multiplan PHCS |
$661.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.28
|
| Rate for Payer: UHCCP Medicaid |
$386.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.68
|
|
|
TCD VASACTIVITY STDY W/INJ
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
32000300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.90 |
| Max. Negotiated Rate |
$1,058.88 |
| Rate for Payer: Aetna Commercial |
$849.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$860.34
|
| Rate for Payer: Cash Price |
$551.50
|
| Rate for Payer: Cigna Commercial |
$915.49
|
| Rate for Payer: First Health Commercial |
$1,047.85
|
| Rate for Payer: Humana Commercial |
$937.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$904.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$970.64
|
| Rate for Payer: Ohio Health Group HMO |
$827.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$761.07
|
| Rate for Payer: PHCS Commercial |
$1,058.88
|
| Rate for Payer: United Healthcare All Payer |
$970.64
|
|
|
TCD VASACTIVITY STDY W/INJ(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
320P0300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$388.28 |
| Rate for Payer: Aetna Commercial |
$239.03
|
| Rate for Payer: Ambetter Exchange |
$298.68
|
| Rate for Payer: Anthem Medicaid |
$174.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.42
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$331.11
|
| Rate for Payer: Healthspan PPO |
$255.34
|
| Rate for Payer: Humana Medicaid |
$174.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.60
|
| Rate for Payer: Molina Healthcare Passport |
$174.12
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.28
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.68
|
|
|
TCD VASACTIVITY STDY W/INJ(T
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
320T0300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$567.84
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
TCD VASACTIVITY STDY W/INJ(T
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS 93893
|
| Hospital Charge Code |
320T0300
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem Medicaid |
$250.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$567.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Humana KY Medicaid |
$250.36
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$252.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$255.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$582.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.32
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
TCD VASACTIVITY STDY W/O INJ
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$843.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$854.88
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cigna Commercial |
$909.68
|
| Rate for Payer: First Health Commercial |
$1,041.20
|
| Rate for Payer: Humana Commercial |
$931.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$808.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$964.48
|
| Rate for Payer: Ohio Health Group HMO |
$822.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.24
|
| Rate for Payer: PHCS Commercial |
$1,052.16
|
| Rate for Payer: United Healthcare All Payer |
$964.48
|
|
|
TCD VASACTIVITY STDY W/O INJ
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna Commercial |
$843.92
|
| Rate for Payer: Anthem Medicaid |
$376.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$854.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cigna Commercial |
$909.68
|
| Rate for Payer: First Health Commercial |
$1,041.20
|
| Rate for Payer: Humana Commercial |
$931.60
|
| Rate for Payer: Humana KY Medicaid |
$376.91
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$380.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$898.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$808.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$964.48
|
| Rate for Payer: Ohio Health Group HMO |
$822.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.24
|
| Rate for Payer: PHCS Commercial |
$1,052.16
|
| Rate for Payer: United Healthcare All Payer |
$964.48
|
|
|
TCD VASACTIVITY STDY W/O INJ
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna Commercial |
$238.51
|
| Rate for Payer: Ambetter Exchange |
$262.10
|
| Rate for Payer: Anthem Medicaid |
$177.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$262.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$262.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$314.52
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cigna Commercial |
$339.72
|
| Rate for Payer: Healthspan PPO |
$254.77
|
| Rate for Payer: Humana Medicaid |
$177.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$262.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.99
|
| Rate for Payer: Molina Healthcare Passport |
$177.44
|
| Rate for Payer: Multiplan PHCS |
$657.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$340.73
|
| Rate for Payer: UHCCP Medicaid |
$383.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$262.10
|
|
|
TCD VASACTIVITY STDY W/O INJ(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
320P0299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$340.73 |
| Rate for Payer: Aetna Commercial |
$238.51
|
| Rate for Payer: Ambetter Exchange |
$262.10
|
| Rate for Payer: Anthem Medicaid |
$177.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$262.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$262.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$314.52
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$339.72
|
| Rate for Payer: Healthspan PPO |
$254.77
|
| Rate for Payer: Humana Medicaid |
$177.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$262.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.99
|
| Rate for Payer: Molina Healthcare Passport |
$177.44
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$340.73
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$262.10
|
|
|
TCD VASACTIVITY STDY W/O INJ(T
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
320T0299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem Medicaid |
$256.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Humana KY Medicaid |
$256.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$259.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
TCD VASACTIVITY STDY W/O INJ(T
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 93892
|
| Hospital Charge Code |
320T0299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.80 |
| Max. Negotiated Rate |
$716.16 |
| Rate for Payer: Aetna Commercial |
$574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$581.88
|
| Rate for Payer: Cash Price |
$373.00
|
| Rate for Payer: Cigna Commercial |
$619.18
|
| Rate for Payer: First Health Commercial |
$708.70
|
| Rate for Payer: Humana Commercial |
$634.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$611.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$550.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$656.48
|
| Rate for Payer: Ohio Health Group HMO |
$559.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.74
|
| Rate for Payer: PHCS Commercial |
$716.16
|
| Rate for Payer: United Healthcare All Payer |
$656.48
|
|
|
TD ADSORBED,PRESERVATIVE FREE
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
77000042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TD ADSORBED,PRESERVATIVE FREE
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
77000042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TD ADSORBED,PRESERVATIVE FREE
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
77000042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.23 |
| Max. Negotiated Rate |
$103.20 |
| Rate for Payer: Ambetter Exchange |
$36.37
|
| Rate for Payer: Anthem Medicaid |
$27.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.64
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Healthspan PPO |
$26.23
|
| Rate for Payer: Humana Medicaid |
$27.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.50
|
| Rate for Payer: Molina Healthcare Passport |
$27.94
|
| Rate for Payer: Multiplan PHCS |
$103.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.28
|
| Rate for Payer: UHCCP Medicaid |
$60.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.37
|
|
|
TD ADSORBED,PRESERVATIVE FRE(T
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
770T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TD ADSORBED,PRESERVATIVE FRE(T
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
770T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TDAP 7 YEARS OR OLDER
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77000043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$145.20 |
| Rate for Payer: Ambetter Exchange |
$39.71
|
| Rate for Payer: Anthem Medicaid |
$35.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.65
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Humana Medicaid |
$35.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.35
|
| Rate for Payer: Molina Healthcare Passport |
$35.64
|
| Rate for Payer: Multiplan PHCS |
$145.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.62
|
| Rate for Payer: UHCCP Medicaid |
$84.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.71
|
|
|
TDAP 7 YEARS OR OLDER
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77000043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem Medicaid |
$83.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.76
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Humana KY Medicaid |
$83.22
|
| Rate for Payer: Kentucky WC Medicaid |
$84.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
|
TDAP 7 YEARS OR OLDER
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
77000043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$232.32 |
| Rate for Payer: Aetna Commercial |
$186.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.76
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cigna Commercial |
$200.86
|
| Rate for Payer: First Health Commercial |
$229.90
|
| Rate for Payer: Humana Commercial |
$205.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$198.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$178.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.96
|
| Rate for Payer: Ohio Health Group HMO |
$181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.98
|
| Rate for Payer: PHCS Commercial |
$232.32
|
| Rate for Payer: United Healthcare All Payer |
$212.96
|
|
